Congestive Heart Failure (CHF) and Related Acute Cases

History Taking and Initial Care
👀 Pyelonephritis – Check for fever and urination pain and monitor body temperature rise
👀 FEMORAL FRACTURE – Check accident progress and pain area, check blood pressure and pain score
👀 Pulmonic embolism – Check for shortness of breath and oxygen saturation
👀 Pneumonia – Cough, phlegm color change, body temperature, respiratory rate check
👀 Congestion heart failure (CHF) – Check swelling and shortness of breath, monitor weight change
👀 Myocardial infarction (MI) – Check the location and duration of chest pain, check blood pressure and heart rate
👀 Stroke – Check the time and speech impairment of symptoms, observe blood pressure
👀 Diabetic ketoacidosis (DKA) – Check thirst and frequency of urination, check respiratory rate (Kussmaul breathing)
👀 Sepsis – Check fever, history of infection, monitor changes in body temperature and heart rate

Comprehensive Simulation Scenario for Nurse Training: Congestive Heart Failure (CHF) and Related Acute Cases

Scenario Title: Structured Interview, Vital Signs Monitoring, and Diagnostic Preparation for Gastroenteritis

Setting: Medical-Surgical Unit / Outpatient Department

Characters:

Nurse (RN) – Responsible for the comprehensive assessment of the patient
Mr. Minseok Choi (Patient) – 38-year-old male presenting with gastrointestinal symptoms

Phase 1: Patient Identification and Introduction

Nurse: Good morning, Mr. Choi. I’m the nurse assisting you today. Could you confirm your full name and date of birth?

Patient: Good morning. My name is Minseok Choi, and my date of birth is October 20, 1985.

Nurse: Thank you, Mr. Choi. I’ll ask you a few questions to understand your current condition better. Everything you share will remain confidential. If you feel uncomfortable at any point, please let me know.

Phase 2: History of Present Illness (HPI)

Nurse: When did your symptoms first begin?

Patient: About a day and a half ago.

Nurse: On a scale of 1 to 10, how severe would you say your diarrhea or vomiting is?

Patient: It’s about an 8.

Nurse: How many times a day are you experiencing diarrhea or vomiting?

Patient: I’ve had diarrhea about six times today, and I’ve vomited three times.

Nurse: Have you experienced any other symptoms like fever, abdominal pain, or nausea?

Patient: Yes, I’ve had mild abdominal pain and some nausea, but no fever.

Nurse: Have you eaten anything recently that might be suspicious, such as seafood or undercooked food?

Patient: I had sushi two nights ago. That’s the only thing I can think of.

Nurse: Do your symptoms worsen or improve under certain conditions?

Patient: They seem worse when I try to eat or drink anything.

Phase 3: Past Medical History (PMH)

Nurse: Have you experienced similar symptoms before?

Patient: Yes, but it wasn’t this bad.

Nurse: Do you have any chronic illnesses, such as diabetes or conditions affecting your immune system?

Patient: No, I don’t have any chronic illnesses.

Phase 4: Family History (FH)

Nurse: Has anyone in your family recently experienced similar symptoms?

Patient: No, not that I know of.

Nurse: Does anyone in your family have a history of digestive illnesses?

Patient: My father had irritable bowel syndrome, but nothing serious.

Phase 5: Social History (SH)

Nurse: Have you traveled recently? If so, where did you go?

Patient: No, I haven’t traveled recently.

Nurse: Have you been in contact with anyone showing similar symptoms?

Patient: Yes, my coworker mentioned feeling sick last week, but I’m not sure what they had.

Phase 6: Medication History and Allergies

Nurse: Are you currently taking any medications or supplements?

Patient: No, I’m not taking anything right now.

Nurse: Have you ever had any allergic reactions to medications?

Patient: No, I’ve never had any allergic reactions.

Nurse: Do you have any known allergies to foods or environmental factors?

Patient: No, I don’t have any allergies.

Phase 7: Vital Signs Measurement

Nurse: Mr. Choi, I’ll now measure your vital signs to evaluate your current condition. Please let me know if you feel any discomfort during the process.

7.1 Temperature Measurement

Nurse: I’ll start by measuring your temperature using a tympanic thermometer. I’ll gently insert the thermometer into your ear. Please remain still.

(The nurse performs hand hygiene, attaches a probe cover to the thermometer, and gently pulls the patient’s ear upward and back to straighten the ear canal. She positions the thermometer snugly and presses the button to begin measurement.)

Nurse: Your temperature is 37.6°C, which is slightly elevated and may indicate a mild fever.

7.2 Blood Pressure Measurement

Nurse: Next, I’ll measure your blood pressure. Please rest your arm here at heart level. The cuff may feel tight as it inflates.

(The nurse performs hand hygiene, wraps the cuff around the patient’s upper arm, positions it 2–3 cm above the elbow, and inflates the cuff while auscultating.)

Nurse: Your blood pressure is 130/85 mmHg, which is slightly elevated and could be linked to mild dehydration.

7.3 Pulse Rate Measurement

Nurse: Now I’ll check your pulse. Please remain relaxed.

(Nurse finds the radial artery and counts the pulse for a full minute.)

Nurse: Your pulse rate is 98 beats per minute, which is a bit high and consistent with dehydration.

7.4 Respiratory Rate Measurement

Nurse: Lastly, I’ll assess your breathing. Please breathe normally.

(Nurse discreetly observes chest movements for one minute.)

Nurse: Your respiratory rate is 22 breaths per minute, which is elevated and aligns with your current symptoms.

Phase 8: Clinical Summary and Immediate Actions

Nurse: Based on the findings:

Mild fever (37.6°C)
Slightly elevated blood pressure (130/85 mmHg)
Slightly increased pulse (98 bpm)
Rapid breathing (22 breaths/min)

These signs point to dehydration likely due to gastroenteritis. We will conduct the following tests:

Stool culture and analysis – to identify infectious agents.
Blood tests – to check for electrolyte imbalance and infection.
Urinalysis – to assess hydration status and rule out other causes.

We’ll also begin oral or IV rehydration, depending on your tolerance and clinical status.

Phase 9: Patient Education and Support

Nurse: These tests are simple and mostly non-invasive. If anything causes discomfort, please let us know right away.

While we wait for results:

Drink clear fluids in small, frequent sips.
Avoid solid foods and dairy products until your stomach settles.
Notify us if symptoms worsen or if you feel faint, dizzy, or have signs of worsening dehydration (such as dark urine or confusion).

Patient: Will I need to be admitted?

Nurse: That depends on the test results and how well you respond to initial treatment. If dehydration is severe or an infection is confirmed, we may recommend hospitalization for monitoring and IV treatment.

Patient: Understood. Thank you for explaining everything clearly.

Nurse: You’re welcome, Mr. Choi. Let’s start with the stool test. I’ll help you with the instructions.

Learning Objectives for Nurse Trainees

Conduct structured interviews focusing on GI symptoms and infectious risk
Assess and interpret vital signs associated with fluid loss and infection
Prepare and educate patients for diagnostic procedures and rehydration
Recognize early signs of dehydration and need for escalation of care

End of Scenario

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